Besisik F, Sürücü F, Mungan Z, Dinçer D, Kapran Y, Kaymakoglu S, Cevikbas U
Department of Gastroenterohepatology, Istanbul Medical Faculty, Capa, 34 390 Istanbul, Turkey.
Hepatogastroenterology. 2001 Nov-Dec;48(42):1772-5.
BACKGROUND/AIMS: Helicobacter pylori infection is the most common cause of gastroduodenal diseases. The role H. pylori eradication in functional dyspepsia patients is contradictory. We performed this study to determine the effects of H. pylori eradication in functional dyspepsia patients with respect to physiological and histological parameters including esophageal sphincter functions.
We studied 20 functional dyspepsia patients, whose H. pylori infection was confirmed by histology and urease test. We also confirmed eradication using the same methods after three months. We performed 24-hour esophageal pH monitoring, esophageal manometry, meal stimulated gastrin release test and measured dyspepsia severity score and gastric emptying time before and three months after eradication. Eradication regimen consisted of omeprazol 20 mg b.i.d., clarithromycin 500 mg b.i.d. and metranidazol 500 mg b.i.d., for two weeks. Gastric inflammation and H. pylori density within biopsy samples from the antrum (n = 4), corpus (n = 4), cardia (n = 2), fundus (n = 2), duodenum (n = 2) and distal esophagus (n = 1) were assessed.
Dyspepsia severity score (P < 0.001), meal stimulated gastrin levels, upper (P = 0.01) and lower (P = 0.06) sphincter pressures were decreased after eradication irrespective of gastric histology; but gastric emptying times (P = 0.87) and pH < 4.5% reflux (P = 0.91) were not changed significantly.
H. pylori eradication results in decreased esophageal sphincter pressures irrespective of gastric histology in functional dyspepsia patients. These decreases are not associated with increased objective reflux or reflux symptomatology. The clinical significance of these finding deserves further evaluations.
背景/目的：幽门螺杆菌感染是胃十二指肠疾病最常见的病因。幽门螺杆菌根除在功能性消化不良患者中的作用存在争议。我们开展这项研究以确定幽门螺杆菌根除对功能性消化不良患者生理和组织学参数（包括食管括约肌功能）的影响。
我们研究了20例功能性消化不良患者，其幽门螺杆菌感染通过组织学和尿素酶试验确诊。三个月后我们使用相同方法确认幽门螺杆菌已被根除。我们进行了24小时食管pH监测、食管测压、进餐刺激胃泌素释放试验，并在根除前后测量消化不良严重程度评分和胃排空时间。根除方案为奥美拉唑20毫克，每日两次，克拉霉素500毫克，每日两次，甲硝唑500毫克，每日两次，疗程两周。评估胃窦（n = 4）、胃体（n = 4）、贲门（n = 2）、胃底（n = 2）、十二指肠（n = 2）和食管远端（n = 1）活检样本中的胃炎症和幽门螺杆菌密度。
无论胃组织学情况如何，根除后消化不良严重程度评分（P < 0.001）、进餐刺激胃泌素水平、上（P = 0.01）下（P = 0.06）括约肌压力均降低；但胃排空时间（P = 0.87）和pH < 4.5%反流（P = 0.91）无显著变化。
在功能性消化不良患者中，无论胃组织学情况如何，根除幽门螺杆菌均导致食管括约肌压力降低。这些降低与客观反流增加或反流症状无关。这些发现的临床意义值得进一步评估。
